"Medication Matters"

Leslie A. DeLisle , APRN, PMHCNS-BC

"There is no health without mental health"

10 Signs Your Antidepressant Isn’t Working

For many people, finding the right depression treatment is a trial and error process. The STAR*D Report, the largest study looking at effectiveness of antidepressants, found that only 37 % of people experienced relief of symptoms after trying one medication, and 67 experienced remission after trying four.”

I mentioned that trial and error process, right?! Good news is that based on the symptoms we discuss in your visits, it often steers a provider toward the action of certain antidepressants (some are more activating, some are more calming, for example.

To improve your chances of finding the treatment that works best for you, look for these nine signs your antidepressant isn’t working, isn’t working well enough, or is no longer working like it should:

1. You feel better right away. This is actually a bad sign. Antidepressants work by increasing and balancing feel-good neurochemicals in your brain, including serotonin, dopamine, and norepinephrine, a process that takes some time. Depression relief from an antidepressant usually peaks at 6 to 8 weeks. If you experience an immediate improvement, it is either a medication side effect or placebo effect that will not maintain.

2. You skip doses,… often. This is a big barrier to effective treatment and can actually lead to rebound symptoms of mood instability or severe anxious distress.

3. You experience no relief from depression symptoms after a few months. In my opinion, you should see some improvement within two months of starting the medication. After this amount of time at an adequate dose, adequate dose being very important, likely best to switch to something else.

4. You feel a sudden surge of energy — along with the low mood. Antidepressants can cause problematic activation that may feel like an improvement from a depression that has stolen your energy for months to years, but when the low mood remains, this combination can lead to acting out or put you at increased risk for harm. It would be important to report these symptoms to your clinician right away.

5. You’re experiencing unpleasant side effects. They all have them, so when side effects happen, we switch to another! The good news is that there have been many advances in psychiatric medicine, so when we move through first line medications and evaluate effectiveness and tolerability in an evidence informed manner.

6. Your antidepressant doesn’t pack the punch it used to. If you have ever wondered if you can “become immune to your meds” or “they just stop working”, the answer is yes. The dosage may need to be increased or medication changed to enhance drug action.

7. Your depression gets deeper. This may be a sign that your antidepressant medication regimen may no longer be working. Specific warning signs to look out for include feeling hopeless, losing interest in things you used to find pleasurable, increased guilt, sadness, low energy or motivation, insomnia, agitation or restlessness, or feeling generally out of control.

8. Your depression symptoms have improved, but you’re still not yourself. If you experience some relief on an antidepressant, but it’s not the relief you hoped for, it may be time to try something new.

9. You’re having disruptive mood swings. At times, antidepressant medications can increase mood irritability or mood swings, especially in people who have been considered to have a bipolar spectrum illness. Symptoms to be watchful for are: feeling unusually elated, angry outburns, breaking things, bouts or rage, getting angry in the workplace or with family members that may be uncharacteristic for you.

10. After an extended period on an antidepressant, your depression is gone. After 9 to 12 months of complete remission of symptoms, it may be advisable to stop the antidepressant altogether. I cannot stress enough the importance of doing this in a specific way, prescribed by myself, to slowly taper off to decrease any discomfort to you and to decrease any chance of physical symptoms of withdrawal. Though not life threatening, they can be uncomfortable.